Provigil vs. Adderall for ADD
August 7, 2014 3:03 AM   Subscribe

I take Adderall for ADD, but am growing dissatisfied with it due to what feels like increasing tolerance and dependence, as well as a couple of secondary reasons. I want to talk to my doctor about switching to Provigil, and would like to hear from anybody who has any advice or experience to relate regarding the pros and cons of the two medications. Details within.

I take Adderall IR for ADD, between 40 and 60mg per day—20mg in the morning, 20mg around noon, and either 0, 10, or 20mg in the late afternoon depending on how I'm feeling and what I need to do that day. I also take 150mg of Wellbutrin and 20mg of Lexapro per day for depression. The combination works well for me; it keeps me from sinking into depression and gives me energy and focus to get up and get things done during the day. Finding this combination of drugs has made a huge difference in my quality of life.

However, after being on Adderall for about a year now I am growing dissatisfied with it. I don't like the ups and downs that it causes (well the ups are mostly fine, but the downs are a bummer) and I don't like having to take it thrice a day. I've tried XR but I can't get enough "coverage" from it; most days I really need 12 hours of coverage, and despite trying a few different XR-related strategies I've only been able to get 6-8 hours of coverage at most, even if I stagger it and take it twice a day at which point I might as well just be taking IR again.

I also don't like the fact that I have become fairly dependent on it. If I don't get my Adderall first thing in the morning then it's basically impossible for me to get going, and if I don't get my second dose around lunchtime I start to really fall into a slump. I'm fine as long as I take it, but I don't like being confined to such a rigid medication schedule. The noon dose is especially annoying, since I'm generally at work or some other public place at that time and while I'm not embarrassed about my medications it's still not exactly my favorite thing to talk about. It rarely comes up, but it's still slightly uncomfortable.

Additionally, I feel like I've developed a tolerance. I'm already up around the maximum dosage for this mediation, and I know that its effects are more subtle than they were a few months ago. In some ways this is fine as I don't want it to come on too strong, but recently I've been feeling like my regular dosage just isn't quite cutting it all the time. A lot of people recommend taking a break of two weeks or a month from time to time in order to lower one's tolerance, but I'm not keen on the idea of spending two weeks or a month lying in bed until noon and then moping around the house feeling fuzzy-headed and getting nothing done. That was pretty much me prior to going on Adderall, and it's not something I want to go back to.

Meanwhile, I've been hearing good things about Provigil. It's not approved for ADD (at least in the US) but I know it's frequently prescribed for ADD off-label. It also has a very different mode of action that is supposed to be less vulnerable to tolerance and dependency, and it's a one-a-day medication that I could take in the morning with my antidepressants. It would also be nice not to have to deal with the special tamper-proof prescriptions and the lack of refills and the whole rigmarole associated with a Schedule II prescription. I'm told that Provigil is subjectively rather "different" from Adderall, but nobody has been able to explain to me exactly what they mean by that.

I'm planning to talk to my doctor about the possibility of switching from Adderall to Provigil, and I'd like to hear from the folks here about any experiences they've had doing something similar. If you've tried both medications, what did you feel were the differences and which do you prefer? Are there any benefits or drawbacks to Provigil that I'm not already aware of? Do you have any advice for talking to my doctor about making the switch? Thanks very much for your advice and guidance.
posted by Cashmere Sock Handjob to Health & Fitness (10 answers total) 6 users marked this as a favorite
I have taken a generic stimulant before (an Adderall substitute) and it made me jumpy, like I had a surge of energy. I started cutting my stimulants into quarter-pills because I didn't like that surge of energy. Nuvigil and Provigil don't make me feel a surge of energy. They just make me awake. I take Provigil in the morning and, if I feel beat in the afternoon, I take more. I have a sleep disorder so, come bedtime, I can go to bed usually without a problem even with Provigil but not always. I've definitely had times where I've thought, that was a crazy day, I worked out, never felt hungry, it's 11:00 p.m. at night now and I feel like I could keep working, before I remember that I am not a modafinil-munching robot and I need to sleep.

Similar to you, I also take bupropion. FYI, Provigil = modafinil. Nuvigil = armodafinil. I don't know how else they are different but Nuvigil made me ANGRY. I was taking Nuvigil and mentioned to my doctor that I felt ANGRY all the time when I took it and he switched me to Provigil. One day, I thought, this is silly, I'm just going to take a Nuvigil instead to see if I notice the difference, and by the end of the day, I thought, why am I so cranky ohhhhhh.

I understand not wanting to take an Adderall holiday but can you not take it on the weekends? I've gone weekends without Provigil. I'm a little more tired but if you can't nap on the weekend, when can you?
posted by kat518 at 7:57 AM on August 7, 2014

I haven't ever tried Provigil, but I could not handle the ups and downs of Adderall either (mostly the downs, which for me were very severe).

I'm on Concerta now (which I think is super-extended release Ritalin). It lasts for about 12 hours, doesn't give me extreme ups and downs, and I only need to take it once a day, and I don't experience any sort of down/headache/anxiety/rage/sleepiness when it wears off. My dosage has been increased once in about 4 or 5 years, and I occasionally take a half dose on weekends or days I need to take decongestants (taking one pill instead of my usual two--you can't cut these in half because it interferes with the extended release delivery).

Concerta is still a Schedule II drug, so it's still a bit of a pain getting scripts filled.

Best of luck finding something that works for you.
posted by inertia at 8:28 AM on August 7, 2014 [1 favorite]

Have you considered Dexedrine as an alternative to Adderall? Do you take medication breaks? I would suggest abstaining from Adderall on the weekends, maybe substituting coffee instead if you really can't find the energy to do the things you want to do.

Most of these type of drugs are addictive, so I would focus on your secondary reasons more, especially since I'm reading some anxiety from your mention of taking medication in public.
posted by oceanjesse at 9:33 AM on August 7, 2014

Have you tried anything other than Adderall? I'd suggest discussing the problems with your doctor without suggesting a particular drug, unless you've tried all the options he/she is aware of. People respond very differently to different classes of drugs, so you may or may not respond well to Provigil - but your doctor may have experience with other patients that could help guide the drugs he/she has you try, based on your specific ADD symptoms, response to Adderall, and undesirable side effect profile.
posted by randomnity at 9:42 AM on August 7, 2014

I had a brief period years ago where I got prescribed that stuff, before I was diagnosed with ADD, to deal with the fact that I had something else going on that kept making me faceplant midday. But I don't remember it helping at all with the sorts of things my Adderall helps with now. I would try Strattera first any day of the week. I had an unusually strong set of side effects with it that made staying on it impossible, but if you can stand the nausea while you get used to it (or if you're lucky enough not to get it at all) then what I remember of my attempt was that it basically worked 24/7, it seemed to lift my mood, and in general it was amazing. I've considered making the attempt again a few times, may yet because I really hate the approach that says it's totally okay to only get 8-12 vaguely functional hours out of your day.
posted by Sequence at 10:21 AM on August 7, 2014

I know it doesn't answer the question re: Provigil, but I just recently went back on adderall after a month off it

Seconding the above suggestions to take a break from it - about a month will likely reset any tolerance your body has built up. When you go back on it, try a lower dose - 10mg 2/day is enough for me usually. Sometimes I'll take half a 10mg tablet and wait an hour to take the other half. I've been on it for 3 years and can't imagine what 60mg would feel like - no wonder it's major highs and major lows!

I would add that you should take that time away to try and build some coping skills - I find that just taking a moment, closing my eyes and concentrating on what I need to get done. Trying to be as mindful as I can of my ADD symptoms manifesting.

Diet is a huge one for me - avoiding simple sugars at all costs and reducing carb intake as much as possible.

Sorry if this isn't helpful at all, but I know how much of a struggle this condition can be and finding solutions that work is such a huge change in quality of life.
posted by misterdaniel at 12:57 PM on August 7, 2014

Possible side effect: Provigil is also prescribed for premature ejaculation. If you're a dude and it already takes you a while to get there, it may take even longer on the drug. (I don't know of any research on Provigil + female sexual function.)
posted by momus_window at 1:07 PM on August 7, 2014

I took Provigil for about five years, went off it for three, and went on Adderall for three, though not as high a dosage as you're on. Provigil was a much, much more mellow medication; I never felt "on" the way I did on Adderall. I never had difficulty sleeping on Provigil. And I also never felt motivated to take more Provigil than I was prescribed, whereas I would occasionally want to take more Adderall than I needed, just because it felt good.

I would occasionally have surges of anger on Adderall that I never felt on Provigil; that could be situational though.
posted by cowboy_sally at 8:27 PM on August 7, 2014

I've been on both, and honestly Provigil did very little for me. I'm on concerta these days, which gives me about 11 hours (I seem to metabolize these things quickly), which is better than any other XR or SR I've heard of. Added bonus of a mechanical, not a chemical method of delivery.
posted by Hactar at 6:42 AM on August 8, 2014

I also tried Provigil and got almost nothing out of it aside from mild but persistent nausea and lack of appetite. I had inconsistent results with Adderall, but Vyvanse has worked amazingly well for me. Consistent coverage, not "speedy,"much better ability to focus, but of course, YMMV and IANAD/IANYD.
posted by litera scripta manet at 7:53 PM on August 8, 2014

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